2. Grounded Theory

Question 1

What is grounded theory?

Answer 1

• A widely respected, rigorous, and commonly used method of analysis for qualitative data.
• It is an inductive methodology which requires several iterations of analysis in order to develop themes and eventually generate a theory about a particular phenomenon or the population from which the data has been derived.
• One key feature of Grounded Theory analysis is that it should always be data-driven and the researcher(s) should try not to bias or influence the themes and theory in any way.
  The analyst’s role is to derive, generate, and interpret a theory directly from what the participants have said, rather than hypothesise about what the data could mean in a wider theoretical context.

Question 2

How was it developed?

Answer 2

• Borne out of Sociology, Barney Glaser and Anselm Strauss developed Grounded Theory whilst they worked on a piece of research into the awareness of dying.
• They found that awareness of dying varied enormously between different patients (e.g. premature infants had no awareness; patients on paediatric, geriatric, and emergency wards had varying awareness; oncology patients had high awareness).
• Awareness of dying had a significant impact on how staff interacted with patients (i.e. those with no awareness were given only minimal essential treatment to prevent awareness developing).
  Two years after Glaser & Strauss published Awareness of Dying (1965), they published their methodology in The Discovery of Grounded Theory (1967).

Question 3

The aims of grounded theory?

Answer 3

• To Generate or Discover a Theory: “The discovery of theory from data systematically obtained from social research”
• To Uncover Basic Social Processes: “…to get through and beyond conjecture and preconception to exactly the underlying processes of what is going on, so that professionals can intervene with confidence to help resolve the participant’s main concerns.”
• Not how to resolve the illness
• Grounded theory is inherently geared towards trying to understand the psychological processes
  Your research should attempt to understand how to intervene in order to make someone feel less distressed about treatment they are receiving

Question 4

Key principle: No a prior assumptions

Answer 4

• Researchers are meant to analyse the data without having any preconceived notion of the phenomena or population being studied.
  
  • Interview questions should be broad and open, and answers should be probed by following up on participants’ responses or topics of interest.
  • Exclude any biases to make sure it is data driven
    Ask people to tell their story and probe them e.g. how did you feel, who supported you

Question 5

Key principle: Data-driven analysis

Answer 5

• Grounded theory is an inductive (qualitative) methodology which requires the analyst to use the data to generate themes and theory.
  
  • Analysts must interpret and present the participants’ data and act as a vehicle for the participant voice, rather than they themselves providing theoretical or analyst-driven input to all stages of the analytical process.
    data driven to the greatest extent- ‘buried within the data the most

Question 6

Key principle: Coding in vivo

Answer 6

• The first level of analysis (open coding) requires the analyst to use the verbatim words from their participants to code the transcripts.
  
  • Each level of higher order coding should be able to be traced back to a lower order coding and therefore the participants’ own words. If the participants’ own words cannot be felt in the final themes and theory, then the analyst has not stayed true to the principle.
    Taking the data itself and applying it as a code- different from a thematic analysis as every line of data has a code assigned to it (important hallmark)

Question 7

Key principle: constant comparisons

Answer 7

• Grounded Theory is an iterative methodology which requires the analyst(s) to return to the data multiple times and compares each transcript to the last (i.e. comparing the 2nd to the 1st; and then the 3rd to the 2nd & the 1st; and the 4th to the 3rd, the 2nd & the 1st etc.
  
  • These iterations of analysis are possible, because you do not collect all your data and then analyse in Grounded Theory, but rather you collect and analyse simultaneously.
    Compare each of the transcripts after coding to look for similarities- are there certain codes that appear in more than one transcript? Need to recognise the fact you collect and analyse simultaneously

Question 8

Key principle: reflexive practice

Answer 8

• Researchers should keep ‘memo notes’ throughout the research process (i.e. from study design through to write-up). These notes can be the researcher’s personal reflections, their initial thoughts on the data, or questions to answer in future interviews or analysis.
  
  • Ontology and epistemology is important for Grounded Theory (but not essential for publication of a paper using it). For a classical Grounded Theory approach researchers should adopt a ‘critical realist’ ontology and a ‘realist’ epistemology.
    Reflection is one point in time, reflexive is when you do a process over again and perhaps changing your behaviour accordingly- in qual data that means changing interviewing techniques to optimise data collection e.g. on the phone or in person

Question 9

key principle: theoretical sampling

Answer 9

• Researchers and analysts should be naïve to the topic area(s) and/or population(s) of interest and therefore should reflect at each stage of the analysis to check for their biases, or potential gaps in the data collected.
  If there is something which has come through in the data, you can target specific participants, or emphasise particular aspects of your topic guide in subsequent interviews.

Question 10

key principle: testable theory

Answer 10

• Once you have generated your theory you now have a working testable theory.
  
  • This means you can take your theory and use it as a testable hypothesis in new populations or similar phenomena to see whether the theory you have generated applies:
  • In a new population (e.g. in an LMIC after developing it in the UK)
    With a new phenomena (e.g. for people who experience parental bereavement after having developed the theory with people who have experienced spousal loss).

Question 11

grounded theory: why do we do it? how is it useful?

Answer 11

• Grounded theory enables the researcher to dig deep into the data and allows the data from the source (i.e. archives, participants, records etc.) to shape the final outcome of the research.
• It is incredibly useful when you are trying to understand a phenomenon or population (or both) of which you have no prior knowledge and/or little is documented either empirically or colloquially.
  As a methodology, it enables the researcher(s) not only to find and present something interesting, but also have a working theory which they can then go and test in new populations or with different phenomena.

Question 12

When is it (not) appropriate?

Answer 12

• Grounded Theory is only ever appropriate if you are attempting to generate a theory about a specific population and/or phenomenon.
• It is therefore not appropriate to use it in evaluative studies (e.g. where you are assessing a service as either ‘good’ or ‘poor’; or for which treatment works better).
• It is an effective methodology for studies which wish to ‘tap into’ behaviours and psychological experiences.
  The experiential nature of the way you ask questions in Grounded Theory studies as well as the topics you would be likely to cover are much more targeted to feelings and experience of an event, identity, illness etc. than most other qualitative methodologies.

Question 13

All is data

Answer 13

• Glaser argued that in Grounded Theory could be applied to all data. This included not only qualitative data, but quantitative, psychometric, statistics, observational, ethnographic and any other data you can collect. (Glaser, 2007)
• It has to be said that Grounded Theory has almost exclusively been used as a qualitative methodology, with the rare addition of quantitative data being analysed with it.
  We depart from traditional Glaserian Grounded Theory dictum and do not suggest “all is data”, but rather utilise Grounded Theory as a rigorous, useful, and valuable qualitative methodological tool for researchers collecting data through transcribed interviews or focus groups, textual matter, field notes, or data taking another written format. (Silverio, Gauntlett, Wallace, & Brown, 2019)

Question 14

Grounded theory for qual health research

Answer 14

• This version of Grounded Theory is hybridised, but heavily classical approach.
• It was devised by me (a Psychologist); two clinical colleagues (Consultant Anaesthetists); and an expert in Clinical Education (a Professor).(Silverio, Gauntlett, Wallace, & Brown, 2019)
• We developed this methodology whilst we were analysing data about the experiences specialist trainee Anaesthetists had as they went through a 6-month long joint Anaesthetic and Surgical training programme for emergency cricothyroidotomies.
  Our Grounded Theory looked at the identity changes these Anaesthetists had to go through to perform, and how the training allowed them to resume their Anaesthetic identity.

Question 15

good cross disciplinary working

Answer 15

• It is often difficult as disciplines have different jargon and ways of implementing research.
• To be truely cross-disciplinary, there must be an emphasis on collaboration rather than ownership between partners; an appreciation of the needs of each discipline, be they professional, educational, or research-orientated; all aided by an open and honest line of communication between all partners.
• Researchers should develop an ability to be clear about your explanations and be prepared to interpret them in non-discipline-specific jargon.
  The team must have an openness to speak-up when they disagree with interpretations of findings and challenge where necessary; whilst demonstrating a real willingness to negotiate interpretations of findings, standing firm on some points, and conceding/deferring on others.

Question 16

phases and stages

Answer 16

• Our method is derived from the Classical Grounded Theory Methodology.
• It has 9 Phases and 20 Stages.
• Some of these stages should be conducted independently by analysts before cross-checking with collaborators.
  Others require analysts to work together for the whole stage.

Question 17

designing a qualitative grounded theory study

Answer 17

• Almost always Grounded Theory analysis is used on data collected from qualitative studies.
• Interview questions should focus on people’s experiences and events over the lifecourse which will allow participants to speak about the vent and the meaning they applied to it (how it was perceived).
  Patient/Participant and Public Involvement and Engagement [PPIE] groups are essential for ensuring that your interview schedules are appropriate, sensitive, and contain questions which both make sense and are understandable.

Question 18

interviewing participants

Answer 18

• Before you recruit any participants ensure that you are comfortable with the interview schedule and that you have rehearsed it plenty of time to the point that you know it verbatim.
• Mock interviews within the research team are a really good way of avoiding poor interviews with participants.
  If possible try and undertake a mock interview with one of your PPI who will not be as involved in the research questions as your team and so may add fresh perspective.

Question 19

cleaning data

Answer 19

• Read through the transcript whilst listening to the original audio and checking that the written record is an accurate reflection of the audio record.
• Doing this provides the opportunity for researchers to re-familiarize themselves with the interview, or in cases where other members of the research team are checking transcripts of interviews that they themselves did not conduct.
• Researchers can now add some of the contextual matter into the transcripts if transcribers have only offered an intelligent transcription service.
  Transcripts can now be printed for hand-coding or uploaded into Microsoft Word for electronic hand coding.

Question 20

doing grounded theory

Answer 20

• Label every part of the data in a line-by-line process using words taken from the participant’s interview text, through the whole transcript.
• Begin to group some of these Open Codes into Focused Codes which encapsulate the meaning of many Open Codes and re-label the whole transcript using these Focused Codes.
• Start to merge Focused Codes together into Super-Categories which should be applicable across multiple participants’ transcripts.
• Super-Categories can be collapsed into one Theme or split to make more than one Theme, but here you should be thinking about what is thematically salient across your whole dataset and within every transcript.
  When you are satisfied that you have achieved theme saturation you can begin to develop your theory. The way in which your themes inter-relate, and either cause, are affected by, or co-occur is the crux of your Theory. Evidence your relationships with supporting quotations from across your dataset.

Question 21

theme development and theory generation

Answer 21

• Some themes may have little support, or will only be present in a select few participants’ data. It is possible to sample more participants who match the demographic characteristics of those individuals whose data contributes to this theme in a process called Theoretical Sampling.
• Consulting Field (‘Memo’) Notes at the theme generation phase ensures the research team has not missed any important information, whilst offering the opportunity for any unanswered questions to be discussed amongst the team, and in doing so will help to contextualise themes.
• Relationships between themes may be processional, causal, reverse, or cyclical, and may have varying degrees of support from a definite relationship to a tentative one.
  The way in which the themes inter-relate, and either cause, are affected by, or co-occur is the crux of the Theory, which can be supported with quotations.

Question 22

defending your theory

Answer 22

• The first defence of your theory should be amongst your research team and it is perfectly okay to disagree with collaborators. Often if everyone is in agreement from the beginning it suggests the data has not been interrogated well enough.
• Disagreements may well ensue for long periods of time and the data may need some re-analysis before a consensus is met.
• After this, defending your theory can be split into two different stages:
  
  • Interpreting Theory (Analysis Section): Application of a meaningful interpretation to the theory you have developed and produce a coherent, logical, and representative narrative to accompany the thematic diagram of the theory.
    Framing Theory (Discussion Section): Turn to published literature to see where their Grounded Theory fits with previously existing theories and findings. Compare your theory to established ones and highlight any similarities and more importantly, any differences.

Question 23

writing up

Answer 23

• Writing-up is yet another opportunity to undertake a further iteration of the analysis.
• All Grounded Theory is ‘data heavy’, meaning analysis sections should allow the data to depict the narrative of the theory more than the researcher’s explanations.
• The supporting narrative should allow readers to be guided seamlessly from quotation to quotation and theme to theme but should not dominate and therefore researchers’ interpretations of quotations should be limited in this data-driven write-up style.
• It is the role of this lead author to ensure the narrative flows not only throughout the analysis, but that the narrative has a clear beginning when the study is introduced, and is then continued until a neat conclusion throughout the text to the end of the manuscript.
• The discussion section provides the opportunity to draw on existing literature and frame the theory which has been generated as part of the study firmly at the centre.
  The trick is to be convincing and that will only happen if the theory has been truely grounded in the participant data.

Question 24

testing your theory

Answer 24

• The reason for using Grounded Theory is to enable an iterative and inductive working-up of data over an extended period, which enables a data-driven theory to be actively generated by the researchers using data extracted from interviewed participants.
• The theory becomes a workable entity which can be tested in different populations to see whether it is relevant, reliable, and valid in new populations.
  In light of new data and evidence, an existing theory may be subject to revisions, adapted, or updated to reflect cultural shift, modern perspectives, or newly acquired data which departs from the theory.